Quality Assessment of Systematic Reviews on Short Dental Implants

Background: Critical analysis of published systematic reviews may help in understanding their strengths and weaknesses and identifying areas that need improvement. Short dental implants are becoming an important addition to the existing dental armamentarium. The aim of this overview is to analyze the quality of published systematic reviews focused on short dental implants using established checklists such as the assessment of multiple systematic reviews (AMSTAR). Methods: A search was conducted to retrieve reviews that used a systematic approach in article selection focusing on short dental implants in humans. Based on a set of inclusion and exclusion criteria, a total of 10 reviews were selected. Two independent reviewers appraised the quality of the selected reviews using AMSTAR and the checklist proposed by Glenny et al. in 2003. Each article was given a total score based on the number of criteria that it fulfilled. Results: Six reviews satisfied ≤4 of the 11 AMSTAR items, and only two reviews satisfied nine of the 11 items. This study shows that published systematic reviews on short dental implants exhibit significant structural and methodological variability. Quality assessment using the Glenny checklist further confirmed the variability in the way systematic reviews were conducted and/or reported. A high correlation was observed between the two checklists’ scores. Conclusions: Uniformity in the way systematic reviews are conducted and/or reported will increase the validity and clinical applicability of future reviews.     

Methodological Quality Assessment of Meta-analyses and Systematic Reviews of the Relationship Between Periodontal and Systemic Diseases

ObjectivesThe aims of this article are to identify all the published systematic reviews (SRs) and meta-analyses (MAs) that studied the relationship between periodontal and systemic diseases and to assess their quality using 2 scales (the Overview Quality Assessment Questionnaire [OQAQ] and A Measurement Tool to Assess Systematic Reviews [AMSTAR] checklist).MethodsFor SRs and MAs to be included, they should have investigated one of the following systemic diseases: pulmonary conditions, cardiac conditions, endocrine conditions, cancer, blood disorders, psychological conditions, anxiety, depression, mood disorders, and several other diseases. Two investigators screened MEDLINE via PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews. The tools used to evaluate quality were the AMSTAR scale and OQAQ. The protocol was prospectively registered in PROSPERO (CRD42018102208).ResultsThe search strategy found 691 unique articles, 42 of which met the eligibility criteria and were included in this review. Diabetes mellitus was the most investigated disease (14 out of 42 studies), followed by obesity (11 studies) and cardiovascular diseases (5 studies). A total of 40 reviews reported on the characteristics of included studies, and, as per the AMSTAR scale, 39 reviews had an a priori design. The number of reviews that fulfilled the status of publication criterion was the lowest (7 reviews only), followed by the number used in the assessment of publication bias (11 reviews). The number of high-quality reviews was higher with the OQAQ than with the AMSTAR checklist (33 vs 25 studies), but the AMSTAR showed a higher number of medium-quality reviews than the OQAQ (14 vs 6 studies). Both showed the same number of low-quality reviews.ConclusionsHigh-quality SRs and MAs are crucial to understanding the relationship between systemic and periodontal diseases. Medical practitioners must be able to inform patients about oral health and specific periodontal health concerns.     

The association between periodontitis and coronary heart disease: A quality assessment of systematic reviews

BackgroundThe existence of an association between periodontitis and cardiovascular disease has been proposed by investigators in several clinical studies and further confirmed by the results of several systematic reviews. The aim of the Authors' study was to assess the quality of published systematic reviews focused on the association between periodontitis and coronary heart disease (CHD) by using established systematic review assessment checklists.MethodsTwo reviewers conducted a search for systematic reviews focusing on the association between periodontitis and CHD. Three independent reviewers appraised the quality of the selected 13 reviews by using an established and validated assessment tool for systematic reviews and another checklist. They gave each article a total score according to the number of criteria on each checklist that the article fulfilled.ResultsNine reviews satisfied six or more items on the assessment tool, whereas two reviews each satisfied only one item. This assessment shows that published systematic reviews of the periodontitis-CHD association exhibit significant structural and methodological variation, which the authors further confirmed by using the second checklist.ConclusionSystematic reviews of the association between periodontitis and CHD exhibited significant differences in their methodological quality.Practical ImplicationsClinicians should be aware that not all systematic reviews of the periodontitis-CHD association are conducted in a rigorous manner and should be capable of differentiating well-conducted reviews from poorly conducted ones.     

Efficacy of stem cells on periodontal regeneration: Systematic review of pre‐clinical studies

This systematic review aims to evaluate mesenchymal stem cells (MSC) periodontal regenerative potential in animal models. MEDLINE, EMBASE and LILACS databases were searched for quantitative pre‐clinical controlled animal model studies that evaluated the effect of local administration of MSC on periodontal regeneration. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement guidelines. Twenty‐two studies met the inclusion criteria. Periodontal defects were surgically created in all studies. In seven studies, periodontal inflammation was experimentally induced following surgical defect creation. Differences in defect morphology were identified among the studies. Autogenous, alogenous and xenogenous MSC were used to promote periodontal regeneration. These included bone marrow‐derived MSC, periodontal ligament (PDL)‐derived MSC, dental pulp‐derived MSC, gingival margin‐derived MSC, foreskin‐derived induced pluripotent stem cells, adipose tissue‐derived MSC, cementum‐derived MSC, periapical follicular MSC and alveolar periosteal cells. Meta‐analysis was not possible due to heterogeneities in study designs. In most of the studies, local MSC implantation was not associated with adverse effects. The use of bone marrow‐derived MSC for periodontal regeneration yielded conflicting results. In contrast, PDL‐MSC consistently promoted increased PDL and cementum regeneration. Finally, the adjunct use of MSC improved the regenerative outcomes of periodontal defects treated with membranes or bone substitutes. Despite the quality level of the existing evidence, the current data indicate that the use of MSC may provide beneficial effects on periodontal regeneration. The various degrees of success of MSC in periodontal regeneration are likely to be related to the use of heterogeneous cells. Thus, future studies need to identify phenotypic profiles of highly regenerative MSC populations.     

Management of TMD: evidence from systematic reviews and meta‐analyses

Summary This systematic review (SR) synthesises recent evidence and assesses the methodological quality of published SRs in the management of temporomandibular disorders (TMD). A systematic literature search was conducted in the PubMed, Cochrane Library, and Bandolier databases for 1987 to September 2009. Two investigators evaluated the methodological quality of each identified SR using two measurement tools: the assessment of multiple systematic reviews (AMSTAR) and level of research design scoring. Thirty‐eight SRs met inclusion criteria and 30 were analysed: 23 qualitative SRs and seven meta‐analyses. Ten SRs were related to occlusal appliances, occlusal adjustment or bruxism; eight to physical therapy; seven to pharmacologic treatment; four to TMJ and maxillofacial surgery; and six to behavioural therapy and multimodal treatment. The median AMSTAR score was 6 (range 2–11). Eighteen of the SRs were based on randomised clinical trials (RCTs), three were based on case–control studies, and nine were a mix of RCTs and case series. Most SRs had pain and clinical measures as primary outcome variables, while few SRs reported psychological status, daily activities, or quality of life. There is some evidence that the following can be effective in alleviating TMD pain: occlusal appliances, acupuncture, behavioural therapy, jaw exercises, postural training, and some pharmacological treatments. Evidence for the effect of electrophysical modalities and surgery is insufficient, and occlusal adjustment seems to have no effect. One limitation of most of the reviewed SRs was that the considerable variation in methodology between the primary studies made definitive conclusions impossible.     

An overview of systematic reviews on the effectiveness of periodontal treatment to improve glycaemic control

Several systematic reviews with meta‐analyses on the effectiveness of periodontal treatment to improve glycaemic control have been published. So far no overview of these systematic reviews has been performed. The main objective of this report was to assess critically these systematic reviews to provide the reader with a high‐level synthesis of research evidence. MEDLINE (via PubMed) and EMBASE databases were searched independently and in duplicate to identify systematic reviews with meta‐analyses of clinical studies that assessed the relationship between diabetes mellitus and periodontitis. The last database search was performed on 10 March 2015. The reference lists of included systematic reviews were also scrutinized for further publications. The methodological quality of the included systematic reviews was assessed independently with two validated checklists (AMSTAR and OQAQ) by two authors. Disagreements in the assessment were resolved by consensus. A total of 226 potential publications were initially retrieved. Eleven systematic reviews with meta‐analyses were finally included. Glycosylated haemoglobin A1c (HbA1c) was the most commonly used clinical endpoint. Meta‐analytic estimates from systematic reviews generated an average reduction of 0.46% (median 0.40%) of HbA1c in patients with diabetes mellitus who received periodontal treatment. These meta‐analyses had, nevertheless, methodological limitations such as inclusion of trials with different types of risk of bias that hinder more robust conclusions. A recent meta‐analysis that included recently published large randomized controlled trials did not show significant change in the level of HbA1c at the 6 mo follow‐up. The AMSTAR checklist generated results that were more conservative than OQAQ. Findings from this overview do not support the information that periodontal treatment may improve glycaemic control. Methodological issues described in this overview may guide further research on this topic.     

Extent and quality of systematic review evidence related to minimum intervention in dentistry: essential oils, powered toothbrushes, triclosan, xylitol

Objective: To investigate extent and quality of current systematic review evidence regarding: powered toothbrushes, triclosan toothpaste, essential oil mouthwashes, xylitol chewing gum. Methods: Five databases were searched for systematic reviews until 13 November 2010. Inclusion criteria: relevant to topic, systematic review according to title and/or abstract, published in English. Article exclusion criteria were based on QUOROM recommendations for the reporting of systematic review methods. Systematic review quality was judged using the AMSTAR tool. All trials included by reviews were assessed for selection bias. Results: 119 articles were found, of which 11 systematic reviews were included. Of these, six were excluded and five accepted: one for triclosan toothpaste; one for xylitol chewing gum; two for powered toothbrushes; one for essential oil mouthwashes. AMSTAR scores: triclosan toothpaste 7; powered toothbrushes 9 and 11; xylitol chewing gum 9; essential oil mouthwashes 8. In total, 75 (out of 76) reviewed trials were identified. In‐depth assessment showed a high risk of selection bias for all trials. Conclusions: The extent of available systematic review evidence is low. Although the few identified systematic reviews could be rated as of medium and high quality, the validity of their conclusions needs to be treated with caution, owing to high risk of selection bias in the reviewed trials. High quality randomised control trials are needed in order to provide convincing evidence regarding true clinical efficacy.     

Do fixed orthodontic appliances adversely affect the periodontium? A systematic review of systematic reviews

This overview aimed to summarize the available systematic reviews that assess the effects of treatment with fixed orthodontic appliances (FOAs) on the periodontium. Unrestricted electronic search of nine databases and additional manual searches were performed up to January 2019. Systematic reviews and meta analyses that assessed the effect of FOAs on the periodontal parameters were included. The methodological quality of the included reviews was evaluated using the A Measurement Tool to Assess Systematic Reviews2 (AMSTAR 2). The initial search yielded 2529 articles from which 19 were included in the current study. AMSTAR 2 scores ranged from critically low to high quality. The quality of evidence ranged from very low to low. The superiority of the periodontal outcomes of self-ligating brackets over conventional brackets could not be proven. The available evidence regarding the effects of FOAs on the periodontium is controversial and of very low quality. The short-term effects of FOAs were temporary worsening the periodontal parameters. Some conclusions regarding the periodontal outcomes of self-ligating brackets could be withdrawn. Future high-quality trials are required. The review was registered at the International prospective register of systematic reviews with registration number CRD42018106662.     

Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines

Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.     

An AMSTAR assessment of the methodological quality of systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS)

Background

Systematic reviews are not an assembly of anecdotes but a distillation of current best available evidence on a particular topic and as such have an important role to play in evidence-based healthcare. A substantial proportion of these systematic reviews focus on interventions, and are able to provide clinicians with the opportunity to understand and translate the best available evidence on the effects of these healthcare interventions into clinical practice. The importance of systematic reviews in summarising and identifying the gaps in evidence which might inform new research initiatives is also widely acknowledged. Their potential impact on practice and research makes their methodological quality especially important as it may directly influence their utility for clinicians, patients and policy makers. The objectives of this study were to identify systematic reviews of oral healthcare interventions published in the Journal of Applied Oral Science (JAOS) and to evaluate their methodological quality using the evaluation tool, AMSTAR.

Methods

Potentially eligible systematic reviews in JAOS were identified through an electronic search of the Scientific Electronic Library Online (SciELO). Details of the relevant aspects of methodology as reported in these systematic reviews were extracted from the full text publications. Methodological quality was assessed independently by two reviewers using the AMSTAR questionnaire.

Results

Five systematic reviews were identified, one of which was subsequently excluded as it was a review of a diagnostic test. Summary AMSTAR scores for the four included reviews were: 1, 5, 2 and 4 out of a maximum score of 11 (range 1-5, mean 3) with only one of the reviews scoring 5.

Conclusion

AMSTAR evaluation of the methodological quality of the relatively small number of systematic reviews published in JAOS illustrated that there was room for improvement. Pre-publication and editorial appraisal of future systematic reviews might benefit from the application of tools such as AMSTAR and is to be recommended.     

Impact of bisphosphonate therapy on dental implant outcomes: An overview of systematic review evidence

The purpose of this overview was to assess the methods, quality, and outcomes of systematic reviews conducted to evaluate the impact of bisphosphonates on dental implants and the risk of developing bisphosphonate-related osteonecrosis of the jaw after dental implant surgery. An electronic search without date or language restriction was performed in the PubMed/MEDLINE, Cochrane CENTRAL, Web of Science, and LILACS databases (to January 2018). Eligibility criteria included systematic reviews that evaluated the impact of bisphosphonates on implant outcomes. The quality assessment of the included reviews was done using AMSTAR 2 guidelines. The protocol of this overview was registered in PROSPERO (CRD42018089617). The search and selection process yielded seven reviews, published between 2009 and 2017. None of the systematic reviews included in this study obtained the maximum score in the quality assessment. The scientific evidence available demonstrates that patients with a history of bisphosphonate use do not present a higher risk of dental implant failure or marginal bone loss compared to patients who have not used bisphosphonates. The literature also suggests that patients who undergo surgical trauma during the installation of dental implants may be more susceptible to bisphosphonate-related osteonecrosis of the jaw.     

多系统评价评估问卷量表在口腔医学领域中文系统评价应用中的信度和效度评价

目的 评价多系统评价评估问卷（AMSTAR）量表应用于口腔医学领域中文系统评价中的一致性、信度和效度。方法 计算机检索中国生物医学文献数据库、维普中文科技期刊数据库和中国期刊全文数据库,截止日期为 2011年3月1日。手工检索19种中文口腔医学杂志,检索已发表的口腔医学类系统评价。2名评价者分别用总体质量 评估问卷（OQAQ）量表和AMSTAR量表对系统评价进行评价,计算观察者间使用AMSTAR量表的Kappa值,AMSTAR 量表重测信度的级内相关系数（ICC）以及AMSTAR和OQAQ量表得分的最大得分百分比的级内相关系数（结构效度）。 结果 纳入52篇系统评价文献。评价者使用AMSTAR量表的Kappa值为0.81[95%C（I 0.73,0.89）],使用OQAQ量表的 Kappa 值为0.74 [95% CI（0.66,0.83）] 。 重测信度的ICC 为 0.98 [95% CI（0.97,0.99）,P =0.000]。 内部一致性信度Cronbach’α为0.69[95%CI（0.56,0.80）,P=0.000]。AMSTAR和OQAQ量表最大得分百分比的ICC为0.94[95%CI（0.90, 0.97）,P=0.000]。结论 AMSTAR量表在应用于口腔医学领域系统评价时有很好的一致性、信度和效度。AMSTAR 量表可很好的推广至口腔医学领域进行系统评价的方法学质量评价,为医务工作者进行系统评价方法学质量评价时带来了较大的便利。     

Methodological quality assessment of paper-based systematic reviews published in oral health

Objectives

This study aimed to conduct a methodological assessment of paper-based systematic reviews (SR) published in oral health using a validated checklist. A secondary objective was to explore temporal trends on methodological quality.

Material and methods

Two electronic databases (OVID Medline and OVID EMBASE) were searched for paper-based SR of interventions published in oral health from inception to October 2014. Manual searches of the reference lists of paper-based SR were also conducted. Methodological quality of included paper-based SR was assessed using an 11-item questionnaire, Assessment of Multiple Systematic Reviews (AMSTAR) checklist. Methodological quality was summarized using the median and inter-quartile range (IQR) of the AMSTAR score over different categories and time periods.

Results

A total of 643 paper-based SR were included. The overall median AMSTAR score was 4 (IQR 2–6). The highest median score (5) was found in the pain dentistry and periodontology fields, while the lowest median score (3) was found in implant dentistry, restorative dentistry, oral medicine, and prosthodontics. The number of paper-based SR per year and the median AMSTAR score increased over time (median score in 1990s was 2 (IQR 2–3), 2000s was 4 (IQR 2–5), and 2010 onwards was 5 (IQR 3–6)).

Conclusion

Although the methodological quality of paper-based SR published in oral health has improved in the last few years, there is still scope for improving quality in most evaluated dental specialties.

Clinical relevance

Large-scale assessment of methodological quality of dental SR highlights areas of methodological strengths and weaknesses that can be targeted in future publications to encourage better quality review methodology.

     

Periodontal disease and quality of life: Umbrella review of systematic reviews

This umbrella review appraised existing systematic reviews and meta‐analysis to establish the impact of periodontal disease and therapy on general and oral health‐related quality of life. A systematic electronic literature search was carried out in accordance with the PRISMA guideline up to January 2020 using PubMed, LIVIVO, EMBASE and OpenGrey (PROSPERO CRD 42020163831). Hand searching was performed through the reference lists of periodontal textbooks and related journals. All English language‐based systematic reviews and meta‐analysis that assessed the impact of periodontal disease and treatment interventions on general and oral health‐related quality of life were included. Overall, eight articles met the inclusion criteria and their methodological quality was assessed using the AMSTAR2 criteria. Two systematic reviews showed a significant impact of oral conditions on general health‐related quality of life, although the specific impact of periodontal disease remains inconclusive. Three systematic reviews established a negative impact of periodontal disease on oral health‐related quality of life. Another three systematic reviews concluded that periodontal treatment can improve oral health‐related quality of life. Oral conditions, like periodontal disease, can impact the general health‐related quality of life. Periodontal disease is negatively correlated with oral health‐related quality of life, although treatment interventions can improve self‐reported quality of life. In view of the heterogeneity of generic instruments currently utilized to assess the self‐reported quality of life of periodontal patients, the development of a general and oral health‐related quality of life instrument specific for periodontal disease is strongly recommended.     

Class II functional orthopaedic treatment: a systematic review of systematic reviews

This Systematic Review (SR) aims to assess the quality of SRs and Meta‐Analyses (MAs) on functional orthopaedic treatment of Class II malocclusion and to summarise and rate the reported effects. Electronic and manual searches were conducted until June 2014. SRs and MAs focusing on the effects of functional orthopaedic treatment of Class II malocclusion in growing patients were included. The methodological quality of the included papers was assessed using the AMSTAR (Assessment of Multiple Systematic Reviews). The design of the primary studies included in each SR was assessed with Level of Research Design scoring. The evidence of the main outcomes was summarised and rated according to a scale of statements. 14 SRs fulfilled the inclusion criteria. The appliances evaluated were as follows: Activator (2 studies), Twin Block (4 studies), headgear (3 studies), Herbst (2 studies), Jasper Jumper (1 study), Bionator (1 study) and Fränkel‐2 (1 study). Four studies reviewed several functional appliances, as a group. The mean AMSTAR score was 6 (ranged 2–10). Six SRs included only controlled clinical trials (CCTs), three SRs included only randomised controlled trials (RCTs), four SRs included both CCTs and RCTs and one SR included also expert opinions. There was some evidence of reduction of the overjet, with different appliances except from headgear; there was some evidence of small maxillary growth restrain with Twin Block and headgear; there was some evidence of elongation of mandibular length, but the clinical relevance of this results is still questionable; there was insufficient evidence to determine an effect on soft tissues.     

Effectiveness of adjunctive interventions for accelerating orthodontic tooth movement: a systematic review of systematic reviews

This study was aimed to summarise published systematic reviews (SRs) that assess the effects of adjunctive interventions on the acceleration of orthodontic tooth movement (OTM). Electronic and manual searches were performed up to August 2016. Systematic reviews investigating the impact of adjunctive techniques on the promotion of OTM were included. The methodological quality of the included reviews was evaluated using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) scale. The quality of evidence for each intervention was assessed using GRADE. The Jadad decision algorithm was used to select a study to provide body evidence from discordant reviews on the same intervention. A total of 11 SRs were included in this study. AMSTAR scores ranged from 4 to 10 of 11. The quality of evidence ranged from very low to low. The short‐term (1–3 months) effects of low‐level laser therapy (LLLT, 5 and 8 J cm^?2) and corticotomy were supported by low‐quality evidence. The evidence regarding the efficacy of photobiomodulation, pulsed electromagnetic field, interseptal bone reduction, two vibrational devices (Tooth Masseuse and Orthoaccel) and electrical current was of very low quality. Relaxin injections and extracorporeal shock waves were reported to have no impact on OTM according to low‐ and very low‐quality evidence, respectively. Based on currently available information, we conclude that low‐quality evidence indicates that LLLT (5 and 8 J cm^?2) and corticotomy are effective to promote OTM in the short term. Future high‐quality trials are required to determine the optimal protocols, as well as the long‐term effects of LLLT and corticotomy, before warranting recommendations for orthodontics clinics.     

Do in vitro solubility studies on endodontic sealers demonstrate a high level of evidence? A systematic review

Objective: To systematically review the quality of evidence of available in vitro solubility studies on endodontic sealers according to prespecified evidence criteria.

Material and methods: This systematic review was based on the PRISMA guidelines and the AMSTAR measurement tool. A systematic duplicate search of the literature on endodontic sealer solubility studies was conducted in PubMed and Embase databases (until 18 October 2017). Mapping terms to subject headings and free text terms were used and combined with hand searching before exclusion of duplicates. Studies specifically dealing with endodontic sealer solubility were selected. The evidence level was graded (low, medium or high) independently by two investigators following systematic data extraction in pilot forms, which was based on prespecified evidence criteria and the modified CONSORT checklist for in vitro studies on dental materials.

Results: The search retrieved 1053 articles, from which 88 were assessed in full. From the 63 articles retained in the final analysis, 11 were classified as having moderate and 52 as low quality of evidence (0 high). The studies graded as low had low sample size (n?<?10) and/or insufficient details to allow replicability. Most of the studies did not conform to the modified CONSORT checklist and did not include parameters considered relevant in the prespecified criteria.

Conclusions: Existing in vitro studies on the solubility of endodontic sealers do not demonstrate a high quality of evidence. Most of these studies do not present systematic reporting nor employ relevant parameters prespecified in our evidence criteria.     

Patient-related risk factors for implant therapy. A critique of pertinent literature

Background: Treatment planning for dental implants involves the assessment of patient‐related risk factors prior to formulation of a treatment plan. The aim of this review was to assess relevant literature and provide evidence‐based information on the successful surgical placement of dental implants. Methods: An electronic search of Medline, PubMed and the Cochrane Databases of Systematic Reviews was undertaken using a combination of MeSH terms and keywords. A handsearch was also performed and cross‐referenced with articles cited in papers selected. The primary study parameter was implant failure. Results: Forty‐three studies were selected based on specific inclusion criteria. Many studies contain confounding variables, numbers in subcategories are often too small for meaningful statistical analysis, and follow‐up times vary and are often short‐term. Conclusions: There are many risk factors which the clinician is required to know and understand to advise patients, and consider in planning and treatment provision. Consistent evidence exists to show an increased failure rate with smokers, a history of radiotherapy and local bone quality and quantity. Weaker evidence exists to show a higher incidence of peri‐implant disease in patients with a history of periodontitis‐related tooth loss. Lack of evidence precludes definitive guidelines for patients with autoimmune disorders where expert opinion recommends caution. Osteoporotic patients show acceptable survival rates; however patients on oral bisphosphonates show a small incidence but high morbidity from osteonecrosis of the jaw. Emerging evidence suggests that there is a correlation between genetic traits and disruption of osseointegration.